S1060 1R

An Act concerning geriatric falls and making an appropriation.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. The Legislature finds and declares that:

a. Geriatric falls, which are the leading cause of death and hospitalization among people 65 years of age or older in New Jersey, constitute a costly public health crisis for New Jersey;

b. Reducing preventable adverse events, such as elder falls, is an important aspect to improving the safety of elderly people in the State;

c. Approximately 85 percent of fall-related hospitalizations and 77 percent of fall-related deaths occur among people who are 75 years of age or older;

d. Nationwide, it is estimated that approximately 400,000 hip fractures occur each year, with 90 percent of those fractures occurring in patients older than 65 years of age. Moreover, it is projected that this number will increase by a factor of 50 percent by the year 2025;

e. The Medicaid program is funded equally by federal and State money, and increased costs from the falls of elderly people receiving health care benefits under the program mean additional costs to the State;

f. AARP estimates that each year over 55,000 older New Jersey residents suffer fall-related injuries resulting in emergency room visits, hospitalizations, and long-term care. It is estimated that the New Jersey Medicaid program will spend in excess of $1 billion per year on geriatric fall-related injuries;

g. The State should devote additional resources to research regarding the prevention and treatment of falls in residential ¹[and institutional]¹ settings;

h. A Statewide approach, which focuses on the daily life of elderly people in residential ¹[, institutional,]¹and community settings and includes input from a wide range of organizations and individuals, including family members and health care professionals, is needed to help reduce elder falls;

i. Since 2000, several states have implemented fall prevention programs for the elderly to reduce the number of falls and fall-related injuries and to reduce associated costs to their Medicaid programs. A program in Pennsylvania reportedly reduced fall-related hospitalizations by 64 percent and cut acute care Medicaid costs by 80 percent for 2,394 elderly Medicaid recipients over a three-year period. Florida reportedly achieved a 60 percent reduction in injurious falls among 6,060 older Medicaid recipients, and its Medicaid program achieved a return of $2.40 for every dollar invested in the program. New York State’s Medicaid fall prevention program enjoyed similarly successful results, with a return of over $3.00 for every dollar invested in its program;

j. New Jersey should join these states in reducing the frequency, severity, and cost of geriatric falls by establishing a ¹community-based¹ comprehensive geriatric fall prevention pilot program modeled on successful programs adopted in other states; and

k. This act is intended to be financially self-supporting, as it is anticipated that reductions in the number and severity of fall-related injuries, as well as resulting nursing home admissions, will result in savings to the State Medicaid program.

2. a. There is established, in the Department of Human Services, a three-year "Comprehensive Geriatric Fall Prevention Pilot Program" under which at least 6,000 Medicaid recipients 60 years of age or ¹[over] older¹ will receive proven fall-prevention services, including, but not limited to, proven interventions that prevent falls and rehabilitative services for fall victims that help prevent subsequent falls. This pilot program shall provide intensive fall prevention programs for ¹[the elderly Medicaid recipients] 3,000 high risk Medicaid recipients 60 years of age or older,¹ most in need of such services, as determined by the Commissioner of Human Services, and shall provide a less intensive but effective program for ¹[all Medicare-Medicaid dual eligible beneficiaries] 3,000 lower risk Medicaid recipients 60 years of age or older¹. The purpose of this program shall be to develop effective strategies to reduce elder falls and the associated costs of those falls. The pilot program shall also designate at least 6,000 Medicaid recipients 60 years of age or ¹[over] older¹ to serve as a control group to measure the comparative effects of the pilot program.

b. The Director of the Division of Aging Services in the Department of Human Services shall contract with a qualified organization to administer the pilot program ¹[principally]¹ to ¹[elderly Medicaid recipients] eligible program participants¹, their families and caregivers, and health care professionals. The program shall focus on ways to reduce the risk of falls, and to the extent practicable, shall incorporate strategies to achieve the following goals:

(1) to increase awareness among ¹[elderly recipients] program participants¹, physicians, pharmacists, allied health professionals, community-based health organizations, and others, of fall risk factors and actions that can reduce falls;

(2) to provide state-of-the-art individualized fall risk assessments, including computerized dynamic posturography, application of logistical ¹[aggression] regression¹ models for pharmaceutical fall risk, occupational and physical therapy analysis of gait and balance disorders, and effective risk assessment;

(3) to provide proven individualized counseling on risk mitigation strategies, including consultation with family members of ¹[elderly recipients] program participants¹, caregivers, and providers, where appropriate;

(4) to implement strategies that are proven effective in reducing subsequent falls by elderly fall victims;

(5) to expand proven interventions that prevent falls by ¹[elderly recipients] program participants¹;

(6) to improve the diagnosis, treatment, and rehabilitation of elderly fall victims; and

(7) to assess the risk of falls occurring in various settings.

c. The director shall establish the pilot program in such counties as to be proportional to the number of ¹[Medicare-Medicaid dual eligible] Medicaid¹ beneficiaries in the State and in such other urban areas as deemed appropriate.

¹d. An individual shall be eligible to participate in the Comprehensive Geriatric Fall Prevention Pilot Program established pursuant to this subsection a. of this section if the individual is:

(1) currently enrolled in the State Medicaid program;

(2) 60 years of age or older;

(3) a resident of New Jersey;

(4) not currently a long-term resident of a nursing home or other institutional setting;

(5) not currently a hospice care patient; and

(6) not currently enrolled in any special Medicaid programs or waivers in which the beneficiary’s plan of care documents include the delivery of services designed to reduce the risk of falls.¹

3. The Commissioner of Human Services shall undertake a review of the effects of falls on costs to the State Medicaid program, and the potential for reducing those costs by implementing proven fall prevention services. This review shall include, but not be limited to, a review of the reimbursement policy of the State Medicaid program in order to determine if additional services should be covered or if reimbursement guidelines for fall prevention-related services should be modified.

Not later than three years after the effective date of this act, the commissioner shall evaluate the cost-effectiveness of the pilot program and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), report to the Legislature any findings and recommendations, including recommendations for Statewide implementation of a geriatric fall prevention program.

4. There is appropriated $11.7 million from the General Fund to the Department of Human Services for the purpose of carrying out the pilot program in accordance with this act.

5. This act shall take effect immediately, and shall expire upon the filing of the report required pursuant to section 3 of this act.